Older cancer survivors living in rural areas are more likely to forgo medical and dental care because of financial concerns, compared with those living in urban areas. This is according to a study published by the American Association for Cancer Research.
The study was conducted by a team of researchers, led by Dr. Nynikka Palmer from Wake Forest School of Medicine in Winston-Salem, NC.
This is the first population-based study to focus on the likelihood of cancer survivors in rural and urban areas forgoing health care because of concerns about cost.
Dr. Palmer, postdoctoral fellow in the Department of Social Sciences and Health Policy at the school, and colleagues analyzed data from 7,804 cancer survivors who participated in the National Health Interview Surveys between 2006 and 2010.
These surveys were conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention (CDC).
Among the study participants:
- 1,642 were from rural areas
- 6,162 were from urban areas
- About 49% of them were aged 18 to 64 and primarily received health insurance coverage through their employers, while some of them had no health insurance.
- The remaining 51% were aged 65 or older, and the majority of these survivors were covered by Medicare and supplemental Medicaid or private insurance.
The study used the US Department of Agriculture, Office of Management and Budget’s Rural-Urban Continuum (RUC) codes to categorize participants as rural or urban residents.
The authors used RUC codes because most other studies and reports addressing health care disparities have used similar coding schemes, and this provides the opportunity to compare data across different studies.
Results of the study showed that cancer survivors aged 65 or older were 66% more likely than their urban counterparts to forgo medical care and 54% more likely to forgo dental care because of cost.
Dr. Palmer says, “We found a disparity among older survivors, for whom health insurance coverage through Medicare is almost universal, while no disparity was found for younger survivors after controlling for various factors. This suggests that health insurance coverage alone may not ensure equal access to health care.”
“Cancer survivors who require regular follow-up care after treatment, but do not receive it, may be at risk for other health conditions like diabetes and heart disease, poorer quality of life, and possibly premature death.”
She adds that health care providers and public health officials should familiarize themselves with this inequality in order to help cancer survivors living in rural areas get access to the resources they need.
Palmer and colleagues collected data on three outcomes:
- If the participants delayed or did not get medical care because of cost
- If they could not afford prescription medicine, and
- If they could not afford dental care.
The researchers noted that older cancer survivors in rural areas may have to travel farther to reach a medical provider, incurring greater out-of-pocket costs associated with travel and lost wages.
They may also face challenges with social support and transportation issues if younger family members leave rural areas for better economic opportunities in cities.
Dr. Palmer continues:
“While insurance coverage may not have fully explained rural-urban disparities in older survivors, we did observe strong associations between health insurance and forgoing care.
With the expected changes in health care policies in the forthcoming year, it will be important to assess the impact on rural and urban cancer survivors.”
This study was funded by the National Cancer Institute at the National Institutes of Health.